title: Bilayer reconstruction for parry-romberg syndrome: using a free circumflex scapular artery-based adipofascial flap for both the buccal fat pad and subcutaneous fat.
abstract: OBJECTIVE
  When using a free flap to reconstruct a facial deformity caused by Romberg's disease, it is important to prevent the flap from sagging after the operation. We report a new method of reconstructive surgery using a free subscapular adipofascial flap to prevent this problem.
  
  
  METHODS
  Three female patients (ages 27, 28, and 34 years) with Parry-Romberg syndrome underwent microsurgical free scapular flap transfer for buccal defects. This operation requires making a gingivobuccal sulcus incision and forming a pocket for buccal fat reconstruction by dissecting over the periosteum of the maxillary bone. Preauricular and submandibular incisions are made to create a subcutaneous pocket for flap transfer. After the subscapular flap is elevated, we use its angiogram to observe its vascular pattern. The flap is separated to preserve the main blood vessels horizontal lower branches. The subcutaneous adipose tissue layer uses the horizontal branch, and the buccal fat pad layer the lower branch.
  
  
  METHODS
  After the operations, the adipofascial flaps were in good condition and without postoperative complications. A half year after the first operation, revisional surgery was performed for one patient. No cases showed no sagging of the cheek, and in every case the overall appearance of the buccal region improved significantly.
  
  
  CONCLUSIONS
  Reconstruction of the buccal fat pad and subcutaneous adipose tissue using a free bilobed adipofascial flap nourished by the circumflex scapular artery, returned the adiposal tissue to its normal position, assuring more natural facial contours.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Fukuoka University, Fukuoka, Japan. takuto@adm.fukuoka-u.ac.jp
authors.forename: Takuto
authors.initials: T
authors.lastname: Oyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohjimi
authors.forename: Taro
authors.initials: T
authors.lastname: Makino
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Nishihira
authors.forename: Akiko
authors.initials: A
authors.lastname: Eto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takagi
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D005150:Facial Hemiatrophy / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012540:Scapula; D016038:Skin Transplantation / Q000379:methods; D016896:Treatment Outcome